Bulimia nervosa is an eating disorder characterized by uncontrolled binge eating, self-induced vomiting or other extreme forms of weight control, and overconcern with body shape and weight. Epidemiological surveys suggest that the prevalence of bulimia nervosa is 1-5% among young women. In the past decade, two major approaches to treatment have been developed for this disorder: psychopharmacological treatment with antidepressant medications and structured psychotherapy, most notably cognitivebehavioral therapy. Although the efficacy of each approach is supported by controlled studies, these studies have for the most part been conducted by different investigators at different centers. We now propose (1) to determine, within a single center, the utility of antidepressant medication treatment when combined with either supportive or cognitive-behavioral psychotherapy, and (2) to compare the utility of this form of treatment to that of psychotherapy in the absence of medication. Over 4 years, 100 women of normal weight with chronic and moderately severe bulimia nervosa will be randomized to receive (1) either placebo or an intensive course of antidepressant medication and (2) either supportive or cognitive-behavioral psychotherapy. Changes in eating behavior and in psychological state will be assessed at the termination of active treatment (5 months) and at 3, 6, and 9 month follow-up visits. This study will provide valuable guidelines for the clinician in indicating the most effective and appropriate forms of treatment for patients with bulimia nervosa.